Background:
Juvenile idiopathic arthritis (JIA) is the most common chronic pediatric rheumatologic disease (incidence 34-60/prevalence 133-168/100.000 in Germany. Many children have oligoarthritis (involving 4 or less joints). Oligoarticular JIA may be characterized by refractory inflammation leading to joint damage, impaired quality of life, and poor functional outcomes. Improvement and harmonisation of diagnosis, monitoring, treatment decision and outcome is the aim of the PROKIND protocols.
Objectives:
Improvement and harmonisation of diagnosis, monitoring, treatment decision and prognosis is the aim of the PROKIND protocols, which are based on the treat to target concept.
Methods:
Outcomes from a prospective observational study of patients with newly diagnosed oligoarticular JIA during the first year of treatment were analysed. Disease activity was assessed with the cJADAS-10. The treatment target was to achieve inactive disease (cJADAS ≤1,1) by month 6 after treatment initiation [1]. Treat to target was defined as DMARD escalation or change if the treatment target was not reached. Outcomes at month 12 included inactive disease and the patient-reported outcomes overall-wellbeing, pain, functional ability (CHAQ) and health-related quality of life (HRQoL, PedsQL 4.0).
Results:
272 oJIA patients from 23 paediatric rheumatology institutions in Germany and Austria were recruited, month 6 and 12 data were available for 110 of these patients. Most patients received in addition to NSAIDs intraarticular corticosteroid therapy as initial therapy, and 49% had reached the treatment goal of inactive disease at 6 months, while 51% were not. 14 % received DMARD escalation/change according to T2T approach, while 37% did not. At 12 months 52% with T2T approach had inactive disease while only 32% of the group that did not follow the T2T approach (p=0.032). Those treated according to T2T tended to have a better overall well-being (1.6±2.0 vs 2.2±2.0), less pain (1.2±2.2 vs 2.1±2.6) and a higher physical HRQoL (87±18 vs 82±19) at the 12-month follow-up compared to those not treated with T2T, but there were no significant differences. However, the patients' functional ability (0.2±0.5 vs. 0.2±0.3) and psychosocial HRQoL (86±15 vs. 86±14) were the same in both groups.
Conclusion:
A treat-to-target approach achieves improvement in disease activity of oligoarticular juvenile idiopathic arthritis patients. However, after 12 months, less than half of oligoarthritis patients have inactive disease, which suggest that more aggressive treatment approaches are necessary.
Patient Consent
X Yes, I received consent.
Funding
GBA innovation fond 01VSF18031.
REFERENCES:
[1] Ravelli A, Consolaro A, Horneff G, et al. Treating juvenile idiopathic arthritis to target: recommendations of an international task force.Ann Rheum Dis. 2018 Jun;77(6):819-828.